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462146
TO THE CLERK OF THE CIRCUITCOURT. -
ST. L UG I E CpU~y, FLORIDA:
' .
" This ialny decoration of Domicile and Cttisenship in the State of Florida that I am filing this day in accordance. and is
conformity .vith Section 222.1?. Florida Statutes.
I was former a kgal resident of l~ub? t rn ~ AL and I
1(~7) IState)
resided at l'~7 ~~n S 5 57` Ho.vever. I have changed my domio7e to
(Street and Numbarl
and ata and have been a bona Sde resident of the State of Floridasince 30 day a~f •
_~tjl.is r - 19-?~
- and I reside at ~ ~t
n~/.gc. J~9c.v~ LC~~9~/
IStred sad Nambarl !
,Q c ~
- ST . LUG 1 E Count .Florida.
7
IAt7)
and this statement is to be takes as my decluation o! citizenship, actual legal residentx and domicile in the State of Florida.
t
i~
i
IF FOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAD PURPOSES,
GHILOREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
:9I90rii0 PM3~11
f tLEO A!~C' Ff CUr ,tr
ST. LUC1E CJUN i Y. F ~r..
R06ER POITR ~5
CLERK CiRCt;!T CiC'~ i ~
4~~146
I
I FURTHER CERTIFY that I wt11 register at my Local address When the registration books reopen, and comply with atl
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former damict7e. and I intend to remain in
7. U C I E _ County.
lCit7)
Florida, permanenti,:
~ ~ _ (?Jame)
is ~Y~ rA ,B ~
. S.varb t~ sad su~ • ~ before nn this day of ~r _ ~ -
~ .rte L
;C ~ -
, "
. A.D.19
~
, .
ROGER POI TRAS, GLERK OF G tRGUi T COURT
ST. LUCIE COUNTY, FLORtOA •
BY: ~
_ EPUTY LERK ,f
~~,~~31~ PILE 902